NEUROSURGICAL FOCUS SUPPLEMENTAL MATERIAL

ONLINE ONLY Supplemental material

Malpractice and socioeconomic aspects in neurosurgery: a developing-country reality de Macêdo Filho et al. https://thejns.org/doi/abs/10.3171/2020.8.FOCUS20571

DISCLAIMER The Journal of Neurosurgery acknowledges that the following section is published verbatim as submitted by the authors and did not go through either the Journal’s peer-review or editing process.

©AANS 2020, except where prohibited by US copyright law Neurosurg Focus Mean Mean Mean Mean Mortality Total Total Length Neurosurgical Procedures Complexity Hospitalization Professional Total Length Rate Patients Deaths of Stay Cost Cost Cost of Stay SURGICAL TREATMENT OF Moderate $874.44 $157.36 $1031.80 35.13 13.9 25742 9042 356689 INTRACEREBRAL HEMATOMA SURGICAL TREATMENT OF INTRACEREBRAL HEMATOMA (WITH Moderate $988.45 $193.04 $1181.49 32.21 13.8 4995 1609 69166 COMPLEMENTARY TECHNIQUE) DECOMPRESSIVE CRANIOTOMY Moderate $824.92 $149.33 $974.25 31.91 15.4 36042 11502 553589 EXTERNAL-EXTERNAL SUBGALEAL Mild $867.07 $123.15 $990.22 29.22 12.8 84232 24615 1078320 VENTRICULAR SHUNT CRANIAL TREPANATION FOR NEUROSURGICAL PROPEDEUTICS / Mild $949.37 $113.73 $1063.10 26.81 13.1 6924 1856 91000 IMPLANT FOR MONITORING ICP SURGICAL TREATMENT OF ACUTE Moderate $748.22 $168.51 $916.74 25.58 12.2 56770 14519 690021 SUDDURAL HEMATOMA DECOMPRESSIVE CRANIOTOMY OF Moderate $770.09 $132.87 $902.96 20.58 15.7 5305 1092 83537 POSTERIOR FOSSA CRANIAL TREPANATION FOR NEUROSURGICAL PROPEDEUTICS OR Mild $575.57 $97.37 $672.94 16.71 14.7 814 136 11933 THERAPEUTICS (WITH COMPLEMENTARY TECHNIQUE) INTRACRANIAL ANGIOPLASTY IN VASO- High $1230.44 $117.75 $1348.19 13.56 9 1623 220 14625 SPASM MICROSURGERY FOR ANEURYSM OF THE POSTERIOR BRAIN CIRCULATION High $1553.98 $441.34 $1995.32 13 17.7 769 100 13577 (GREATER THAN 1.5 CM) MICROSURGERY FOR ANEURYSM OF High $1241.88 $224.14 $1466.01 12.69 16.3 709 90 11536 POSTERIOR BRAIN CIRCULATION CRANIOTOMY FOR BRAIN BIOPSY Moderate $625.74 $114.82 $740.56 12.42 17 1562 194 26562 CRANIOTOMY FOR INTRACRANIAL Moderate $575.25 $151.45 $726.70 12.36 10.8 2541 314 27481 FOREIGN BODY REMOVAL MICROSURGERY FOR ANEURYSM OF ANTERIOR BRAIN CIRCULATION High $1490.17 $352.29 $1842.46 11.83 16.7 3686 436 61710 GREATER THAN 1.5 CM INTRACRANIAL VASCULAR MICROSURGERY (WITH High $1411.51 $351.22 $1762.73 11.25 15 14815 1666 221637 COMPLEMENTARY TECHNIQUE) CRANIAL TREPANATION FOR NEUROSURGICAL PROPEDEUTICS OR Mild $445.17 $57.08 $502.25 11.08 15.5 1516 168 23532 THERAPEUTICS CRANIOTOMY FOR BRAIN BIOPSY (WITH Moderate $665.97 $196.44 $862.41 11.02 14.4 1234 136 17781 COMPLEMENTARY TECHNIQUE) MICROSURGERY FOR ANEURYSM OF POSTERIOR BRAIN CIRCULATION LESS High $1554.05 $444.63 $1998.68 11.01 16.9 799 88 13490 THAN 1.5 CM SURGICAL TREATMENT OF Moderate $601.35 $150.49 $751.84 10.86 10 41303 4484 414212 EXTRADURAL HEMATOMA MICROSURGERY FOR ANEURYSM OF ANTERIOR BRAIN CIRCULATION LESS High $1542.11 $365.00 $1907.11 10.42 16.8 4510 470 75651 THAN 1.5 CM SURGICAL TREATMENT OF Moderate $621.43 $132.13 $753.56 9.92 20.8 4646 461 96711 INTRACRANIAL ABSCESS MICROSURGERY FOR ANEURYSM OF High $1181.66 $202.04 $1383.70 9.6 17.3 4085 392 70784 ANTERIOR BRAIN CIRCULATION CRANIOTOMY FOR INTRACRANIAL High $731.29 $137.36 $868.65 9.34 17.2 9018 842 155433 TUMOR REMOVAL MICROSURGERY FOR DEEP CEREBRAL High $1281.32 $285.46 $1566.78 8.95 17.8 1196 107 21333 ARTERIOVENOUS MALFORMATION CRANIOTOMY FOR INTRACRANIAL FOREIGN BODY REMOVAL (WITH Moderate $604.89 $187.59 $792.47 8.69 10.5 679 59 7132 COMPLEMENTARY TECHNIQUE) CORDOTOMY / MYELOTOMY BY High $462.81 $183.57 $646.38 8.63 8.7 278 24 2426 RADIOFREQUENCY CRANIOTOMY FOR REMOVAL OF CYST / Moderate $700.19 $149.89 $850.07 8.3 19 3986 331 75741 ABSCESS / BRAIN GRANULOMA SURGICAL TREATMENT OF CHRONIC Moderate $503.27 $140.97 $644.24 8.09 8.8 52819 4273 462812 SUBDURAL HEMATOMA MICROSURGERY FOR INTRACRANIAL High $939.60 $288.62 $1228.21 7.99 15.8 26786 2141 424150 TUMOR CRANIOTOMY TO REMOVE INCLUSIVE BRAIN TUMOR FROM THE POSTERIOR High $956.84 $222.40 $1179.24 7.8 14.4 14482 1130 209019 FOSSA TREATMENT OF GIANT ANEURISM BY High $689.33 $80.78 $770.11 7.69 9.9 182 14 1793 OCCLUSION OF THE CARRIER VASE CRANIOTOMY FOR REMOVAL OF CYST / ABSCESS / GRANULOMA ENCEPHALIC Moderate $745.51 $153.14 $898.65 7.27 18.2 1624 118 29484 (WITH COMPLEMENTARY TECHNIQUE) EMBOLIZATION OF CEREBRAL ANEURYSM LESS THAN 1.5 CM WITH High $2518.56 $184.83 $2703.39 7.17 8.6 3670 263 31438 NARROW NECK MICROSURGERY FOR SPINAL OR Mild $395.60 $112.48 $508.08 6.93 16.6 404 28 6695 ROOTS CORD BIOPSY EMBOLIZATION OF CEREBRAL ANEURYSM GREATER THAN 1.5 CM High $3332.37 $177.79 $3510.16 6.64 9.2 4822 320 44489 WITH NARROW NECK SURGICAL TREATMENT OF CRANIUM Moderate $443.32 $91.17 $534.48 6.64 9.2 16390 1088 150298 FRACTURE WITH SINKING MICROSURGERY FOR INTRACRANIAL TUMOR (WITH COMPLEMENTARY High $1061.79 $374.32 $1436.12 6.59 13.2 24809 1635 327240 TECHNIQUE) EMBOLIZATION OF CEREBRAL ANEURYSM FROM 8 TO 15MM WITH High $4009.28 $110.70 $4119.98 6.31 7.2 966 61 6954 WIDE NECK MICROSURGERY FOR TUMOR OF THE High $954.60 $318.27 $1272.87 6.23 14 4897 305 68328 BASE OF THE CRANIUM REMOVAL OF VENTRICULAR SHUNT FOR PERITONEUM / ATRIUM / PLEURA / Mild $388.15 $98.36 $486.51 6.2 12.6 3192 198 40134 RAQUE EXTRA / INTRACRANIAL VASCULAR High $1264.96 $302.03 $1566.99 5.92 12.3 169 10 2076 ANASTOMOSIS EMBOLIZATION OF CEREBRAL ANEURYSM FROM 8 TO 15 MM WITH High $3683.95 $110.26 $3794.21 5.8 7.2 1242 72 8953 NARROW NECK EMBOLIZATION OF CEREBRAL High $3183.56 $102.60 $3286.16 5.64 5.6 939 53 5260 ANEURYSM LESS THAN 8 MM WITH AN WIDE NECK EMBOLIZATION OF CEREBRAL ANEURYSM LESS THAN 8 MM WITH High $3096.49 $109.82 $3206.31 5.62 7.2 1707 96 12356 NARROW NECK MICROSURGERY FOR CEREBRAL High $1101.68 $241.34 $1343.01 5.56 16.3 972 54 15811 ARTERIOVENOUS MALFORMATION EMBOLIZATION OF BRAIN ANEURYSM GREATER THAN 1.5 CM WITH WIDE High $3414.41 $170.17 $3584.57 5.45 7.2 8270 451 59653 NECK SURGICAL TREATMENT OF CRANIAL Moderate $612.44 $139.62 $752.06 5.44 12.4 7001 381 86592 LIQUORIC FISTULA TRIGEMINAL AND / OR SPINAL High $463.81 $181.63 $645.44 5.26 13.9 19 1 265 NUCLEOTRACTOMY VENTRICULAR SHUNT FOR PERITONEUM / ATRIUM / PLEURA / Moderate $659.74 $148.93 $808.67 5.24 10.8 93803 4919 1010714 RAQUE EXTERNAL LUMBAR LIQUOR DRAINAGE Mild $563.93 $183.49 $747.42 4.88 9.7 4628 226 44845 EXTRADURAL RACHIMEDULAR TUMOR High $506.22 $127.03 $633.25 4.77 13.5 2430 116 32843 RESECTION SURGICAL TREATMENT OF CAROTID- High $599.16 $162.73 $761.89 4.71 11.6 85 4 990 CAVERNAL FISTULA RAQUE-PERITONEAL SHUNT Moderate $519.68 $122.63 $642.31 4.66 12.8 1222 57 15586 EMBOLIZATION OF CEREBRAL ANEURYSM LESS THAN 1.5 CM WITH High $2628.22 $175.61 $2803.83 4.63 6.4 5400 250 34646 WIDE NECK MICROSURGERY FOR EXTRATEMPORAL UNILOBAR RESECTION WITHOUT INTRA- High $686.83 $220.06 $906.89 4.08 10.2 49 2 500 OPERATIVE MONITORING REVISION OF VENTRICULAR SHUNT FOR PERITONEUM / ATRIUM / PLEURA / Mild $435.07 $119.68 $554.75 4.05 9 13005 527 117358 RAQUE ENDOSCOPIC CEREBRAL High $812.87 $264.19 $1077.06 3.64 10.7 7390 269 78777 MICROSURGERY SURGICAL TREATMENT OF SKULL Moderate $352.09 $79.00 $431.10 3.58 16.4 4442 159 73044 OSTEOMYELITE SURGICAL TREATMENT OF OPEN Moderate $808.93 $184.67 $993.60 3.38 14.5 5115 173 73959 DISRAPHISM MEDULLAR TUMOR MICROSURGERY High $647.88 $188.67 $836.55 3.18 14.1 4091 130 57779 SURGICAL TREATMENT OF SPINAL Moderate $517.22 $131.98 $649.20 3.07 12.5 2866 88 35742 LIQUORIC FISTULA EMBOLIZATION OF SIMPLE DURAL ARTERIOVENOUS MALFORMATION OF High $854.83 $85.22 $940.05 2.89 9.5 622 18 5893 THE CENTRAL NERVOUS SYSTEM BONE TUMOR CRANIECTOMY High $343.42 $119.29 $462.70 2.57 6.6 1673 43 11113 SURGICAL TREATMENT OF OCCULT Moderate $636.96 $148.64 $785.60 2.41 11.6 1496 36 17427 DISRAPHISM EMBOLIZATION OF COMPLEX DURAL ARTERIOVENOUS MALFORMATION OF High $2291.88 $97.29 $2389.17 2.34 6.7 1284 30 8555 THE CENTRAL NERVOUS SYSTEM MICROSURGERY WITH CORDOTOMY / High $433.74 $100.23 $533.96 2.25 11.5 222 5 2559 OPEN MYELOTOMY MICROSURGERY OF MEDULLAR TUMOR High $721.55 $274.16 $995.70 2.14 11 3642 78 40232 WITH COMPLEMENTARY TECHNIQUE SURGICAL TREATMENT OF PLATIBASIA AND MALFORMATION OF ARNOLD Moderate $651.85 $132.02 $783.87 2.12 12.8 1508 32 19295 CHIARI PHARMACEUTICAL INFUSION PUMP High $1748.63 $117.54 $1866.17 2.1 6.3 428 9 2712 INTRATHECAL IMPLANT MICROSURGERY OF SYRINGOMYELIA Moderate $685.68 $183.66 $869.34 2.1 13.3 763 16 10172 STEREOTAXY PAIN TREATMENT High $373.61 $127.32 $500.94 1.92 4.6 52 1 241 CRANIOPLASTY Moderate $421.58 $96.78 $518.36 1.76 7.4 17350 305 128368 EMBOLIZATION OF CAROTID-CAVERNAL High $1010.62 $110.58 $1121.21 1.75 7 228 4 1606 FISTULA WITH DETACHABLE BALLOONS EMBOLIZATION OF ARTERIOVENOUS High $772.01 $112.67 $884.68 1.71 6.6 410 7 2690 FISTULA OF THE HEAD AND NECK TREATMENT BY INJURY OF DEEP CNS STRUCTURE INJURY FOR TREATMENT High $427.08 $148.70 $575.78 1.7 5.6 294 5 1654 OF ABNORMAL MOVEMENTS INTRADURAL AND EXTRAMEDULAR High $616.78 $163.87 $780.66 1.68 11.9 2859 48 33978 TUMOR MICROSURGERY CRANIOPLASTY PLATE REMOVAL Mild $309.60 $77.60 $387.20 1.56 11.7 1603 25 18713 TRANSESPHENOIDAL HYPHOPHYSECTOMY BY High $803.41 $270.66 $1074.07 1.52 12.4 6296 96 77851 COMPLEMENTARY TECHNIQUE EMBOLIZATION OF INTRA-CRANIAL OR High $949.15 $76.97 $1026.12 1.33 5.8 2632 35 15292 HEAD AND NECK TUMOR SURGICAL TREATMENT OF CRANIOSYSINOSIS WITH SINGLE Moderate $307.75 $87.45 $395.20 1.22 6.5 817 10 5295 SUTURE ENDOSCOPIC TRANSESPHENOIDAL High $629.86 $189.68 $819.54 1.19 12.5 759 9 9498 HYPHOPHYSECTOMY NEUROVASCULAR DECOMPRESSION OF High $665.76 $247.83 $913.59 1.13 8.1 1235 14 9993 CRANIAL NERVES INTRAVENTRICULAR IMPLANT FOR High $1550.70 $119.23 $1669.94 1.12 6.7 89 1 594 PHARMACEUTICAL INFUSION PUMP EMBOLIZATION OF INTRAPARENCHYMAL ARTERIOVENOUS High $1392.69 $124.94 $1517.62 1.02 5 5789 59 29154 MALFORMATION OF THE CENTRAL NERVOUS SYSTEM EXTENDED PERIPHERAL / CENTRAL NERVOUS SYSTEM BLOCKS WITH Mild $127.47 $19.59 $147.06 0.96 2.4 19817 190 47760 INFUSION PUMP SURGICAL TREATMENT OF COMPLEX High $547.16 $133.32 $680.48 0.82 6.7 1345 11 9052 CRANIOSYSINOSTOSIS MICROSURGERY FOR EXTRATEMPORAL UNILOBAR RESECTION WITH High $1036.14 $284.02 $1320.15 0.79 10.4 127 1 1318 INTRAOPERATORY MONITORING MICROSURGERY FOR LESIONECTOMY WITHOUT INTRA-OPERATIVE High $638.98 $216.21 $855.18 0.78 8.6 129 1 1103 MONITORING SURGICAL DIAGNOSTIC EXPLORATION FOR UNILATERAL IMPLEMENTATION OF High $718.17 $220.87 $939.04 0.74 8.5 136 1 1160 INVASIVE ELECTRODES (INCLUDES VIDEO MONITORING) MICROSURGERY FOR TEMPORAL LOBECTOMY / AMIGDALO-SELECTIVE High $892.99 $296.54 $1189.53 0.54 8.8 2755 15 24146 HYPOCAMPECTOMY MICRO-SURGERY FOR MULTILOBAR RESECTION / HEMISPHERECTOMY / High $1261.07 $400.09 $1661.17 0.5 12.7 603 3 7633 CHALLOSOTOMY ELECTRODE IMPLANT FOR CEREBRAL High $1023.00 $183.15 $1206.14 0.37 5.8 802 3 4621 STIMULATION MICROSURGERY FOR LESIONECTOMY High $1097.95 $296.72 $1394.67 0.3 9.6 331 1 3162 WITH INTRAOPERATORY MONITORING EXCHANGE OF PULSE GENERATOR FOR High $1496.91 $14.90 $1511.81 0.3 2.9 328 1 950 CEREBRAL STIMULATION PULSE GENERATOR IMPLANT FOR CEREBRAL STIMULATION (INCLUDES High $1849.43 $16.10 $1865.53 0.24 3.8 424 1 1631 CONNECTOR) PERCUTANEOUS RHIZOTOMY WITH Mild $270.07 $92.38 $362.45 0.15 1.9 2065 3 4003 BALLOON SELECTIVE NEUROTOMY OF TRIGEMEO High $354.38 $90.86 $445.24 0.1 4.5 974 1 4404 AND OTHER CRANIAL NERVES MICROSURGICAL TREATMENT OF High $89.75 $28.22 $117.97 0.1 2.1 4107 4 8536 PERIPHERAL NERVE TUMOR / NEUROMA MICROSURGERY WITH OPEN Mild $284.32 $140.38 $424.69 0.09 2.9 2266 2 6478 RHIZOTOMY PERCUTANEOUS RHIZOTOMY BY Mild $252.14 $110.26 $362.41 0.08 1.5 17198 13 26643 RADIOFREQUENCY NON-FUNCTIONAL NEUROLYSIS OF Mild $69.43 $30.46 $99.90 0.04 1 41412 16 42340 PERIPHERAL NERVES BRACHIAL PLEXUS MICROSURGERY High $283.32 $75.42 $358.74 0.03 3.7 3370 1 12532 WITH MICROGRAFTS PERIPHERAL NERVE Moderate $145.86 $38.63 $184.50 0.02 1.3 26323 4 33449 MICRONEUROLYSIS NEURORRHAPHY Mild $82.06 $30.31 $112.37 0.02 2.1 11466 2 24593 SURGICAL DIAGNOSTIC EXPLORATION High $1235.58 $361.30 $1596.88 0 8.5 331 0 2811 FOR BILATERAL IMPLEMENTATION OF INVASIVE ELECTRODES (INCLUDES VIDEO MONITORING) BRACHIAL PLEXUS MICROSURGERY High $150.86 $38.71 $189.57 0 3.5 3971 0 14035 WITH EXPLORATION AND NEUROLYSIS MICRONEURORRHAPHY Moderate $259.03 $57.59 $316.62 0 2.2 9564 0 20864 SUPERSELECTIVE MYECTOMY High $318.07 $117.16 $435.23 0 2.1 17 0 36 SUPERSELECTIVE NEUROTOMY FOR High $333.01 $119.86 $452.87 0 3.8 46 0 173 ABNORMAL MOVEMENTS MULTIPLE SUB-PIAL TRANSACTIONS IN High $577.62 $208.92 $786.54 0 12.9 11 0 142 ELOQUENT AREAS TREATMENT OF ABNORMAL High $383.73 $126.86 $510.59 0 4.9 334 0 1645 MOVIMENTS BY STEREOTAXY TREATMENT OF ABNORMAL MOVIMENTS BY STEREOTAXY WITH High $441.06 $139.69 $580.76 0 5.3 71 0 376 MICRO-REGISTRATION

Supplemental Table 1: DATASUS records